2007 年至 2017 年药物滥用相关性感染性心内膜炎及心脏瓣膜手术趋势：全州出院数据研究。
Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data.
机构信息
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (A.J.S., D.L.R.).
Centers for Disease Control and Prevention, Atlanta, Georgia (A.F.).
出版信息
Ann Intern Med. 2019 Jan 1;170(1):31-40. doi: 10.7326/M18-2124. Epub 2018 Dec 4.
BACKGROUND
Drug use-associated infective endocarditis (DUA-IE) is increasing as a result of the opioid epidemic. Infective endocarditis may require valve surgery, but surgical treatment of DUA-IE has invoked controversy, and the extent of its use is unknown.
OBJECTIVE
To examine hospitalization trends for DUA-IE, the proportion of hospitalizations with surgery, patient characteristics, length of stay, and charges.
DESIGN
10-year analysis of a statewide hospital discharge database.
SETTING
North Carolina hospitals, 2007 to 2017.
PATIENTS
All patients aged 18 years or older hospitalized for IE.
MEASUREMENTS
Annual trends in all IE admissions and in IE hospitalizations with valve surgery, stratified by patients' drug use status. Characteristics of DUA-IE surgical hospitalizations, including patient demographic characteristics, length of stay, disposition, and charges.
RESULTS
Of 22 825 IE hospitalizations, 2602 (11%) were for DUA-IE. Valve surgery was performed in 1655 IE hospitalizations (7%), including 285 (17%) for DUA-IE. Annual DUA-IE hospitalizations increased from 0.92 to 10.95 and DUA-IE hospitalizations with surgery from 0.10 to 1.38 per 100 000 persons. In the final year, 42% of IE valve surgeries were performed in patients with DUA-IE. Compared with other surgical patients with IE, those with DUA-IE were younger (median age, 33 vs. 56 years), were more commonly female (47% vs. 33%) and white (89% vs. 63%), and were primarily insured by Medicaid (38%) or uninsured (35%). Hospital stays for DUA-IE were longer (median, 27 vs. 17 days), with higher median charges ($250 994 vs. $198 764). Charges for 282 DUA-IE hospitalizations exceeded $78 million.
LIMITATION
Reliance on administrative data and billing codes.
CONCLUSION
DUA-IE hospitalizations and valve surgeries increased more than 12-fold, and nearly half of all IE valve surgeries were performed in patients with DUA-IE. The swell of patients with DUA-IE is reshaping the scope, type, and financing of health care resources needed to effectively treat IE.
PRIMARY FUNDING SOURCE
National Institutes of Health.
背景
由于阿片类药物泛滥，与药物使用相关的感染性心内膜炎（DUA-IE）的发病率正在上升。感染性心内膜炎可能需要瓣膜手术，但 DUA-IE 的手术治疗引发了争议，其使用范围尚不清楚。
目的
研究 DUA-IE 的住院趋势、接受手术治疗的住院比例、患者特征、住院时间和费用。
设计
对全州医院出院数据库进行的 10 年分析。
地点
北卡罗来纳州医院，2007 年至 2017 年。
患者
所有因 IE 住院的年龄在 18 岁及以上的患者。
测量
所有 IE 入院人数和接受瓣膜手术的 IE 住院人数的年度趋势，按患者的药物使用状况进行分层。分析 DUA-IE 手术住院患者的特征，包括患者的人口统计学特征、住院时间、出院情况和费用。
结果
在 22825 例 IE 住院患者中，2602 例（11%）为 DUA-IE。在 1655 例 IE 住院患者（7%）中进行了瓣膜手术，其中 285 例（17%）为 DUA-IE。每年 DUA-IE 住院人数从 0.92 增加到 10.95，接受 DUA-IE 手术的住院人数从 0.10 增加到 1.38/10 万人。在最后一年，42%的 IE 瓣膜手术是在 DUA-IE 患者中进行的。与其他接受 IE 手术的患者相比，患有 DUA-IE 的患者年龄更小（中位数年龄，33 岁 vs. 56 岁），女性比例更高（47% vs. 33%），白人比例更高（89% vs. 63%），主要由医疗补助（38%）或无保险（35%）承保。患有 DUA-IE 的患者住院时间更长（中位数为 27 天 vs. 17 天），中位费用更高（250994 美元 vs. 198764 美元）。282 例 DUA-IE 住院患者的费用超过 7800 万美元。
局限性
依赖于行政数据和计费代码。
结论
DUA-IE 住院和瓣膜手术增加了 12 倍以上，近一半的 IE 瓣膜手术是在患有 DUA-IE 的患者中进行的。患有 DUA-IE 的患者人数不断增加，正在重塑有效治疗 IE 所需的医疗资源的范围、类型和融资方式。
主要资金来源
美国国立卫生研究院。
Zotero 插件